Defining criteria and resource use for high dependency care in children: an observational economic study

Objectives: Internationally there is no consensus on defining and funding of paediatric high dependency care (HDC). This study tested whether a new UK Healthcare Resource Group (HRG) classification for HDC, with two categories of basic and advanced HDC, can identify children who consume greater staff resource. It also explored the impact of a change in basic HDC HRG criteria introduced in April 2011.
Design: Observational study of medical and nursing staff resource use.
Setting: 16 paediatric wards across 6 regional hospitals; 1 tertiary children’s hospital (November 2010
to March 2011).
Participants: 1098 infants and children admitted to paediatric wards.
Main outcome measures: Number of children meeting criteria for basic and advanced HDC HRGs;care in a cubicle; medical and nursing staff costs,extrapolated from time spent at patient bedside.
Results: 223 (20.3%) children met original HDC criteria (15.9% basic, 4.4% advanced). This fell to 88 (8.0%) with the change in basic HDC definition (3.6% basic, 4.4% advanced). Children who met original HDC criteria consumed greater bedside staff resource than those not meeting criteria (cost ratio 1.0:1.75:2.96 (non-HDC:basic HDC:advanced HDC)), with revised criteria identifying a (smaller) basic group with greater staff resource use (cost ratio 1.0:2.35:2.76). Being cared for in a cubicle was
not associated with greater staff costs.
Conclusions: HDC HRG criteria identify children who consume significantly greater staff resources. Revision of the definition has resulted in a large reduction of cases meeting the criteria but identifies a group consuming greater staff resources.